Medical Assistance Provider Incentive Repository. User Guide. For Eligible Hospitals

Medical Assistance Provider Incentive Repository User Guide For Eligible Hospitals February 25, 2013

Contents Introduction...1 Before You Begin...2 Complete your R&A registration... 2 Identify one individual to complete the MAPIR application.... 3 Gather the necessary information to facilitate the completion of the required data.... 4 Using MAPIR...4 Step 1 Getting Started...6 Step 2 Confirm R&A and Contact Info...9 Step 3 Eligibility... 13 Step 4 - Patient Volumes... 18 Patient Volume (Part 1 of 3) 90 Day Reporting Period... 19 Patient Volume (Part 2 of 3) - Location... 21 Hospital Cost Report Data Fiscal Year (Part 3 of 3)... 27 Hospital Cost Report Data (Part 3 of 3)... 29 Change Hospital Cost Report Data... 32 Step 5 Attestation... 37 Attestation Phase (Part 1 of 3)... 38 Adoption Phase... 39 Implementation Phase (Part 2 of 3)... 40 Upgrade Phase (Part 2 of 3)... 44 Meaningful Use Phase... 48 Attestation Meaningful Use Measures... 52 Meaningful Use Core Measures... 54 Meaningful Use Menu Set Measures... 83 Meaningful Use Clinical Quality Measures... 113 Meaningful Use Measures Summary... 137 Attestation Phase (Part 3 of 3)... 143 Step 6 Review Application... 145 Step 7 Submit Your Application... 149 Post Submission Activities... 160 Additional User Information... 163 Hover Bubble Definitions... 170 Acronyms and Terms... 174 ii

iii

Introduction MAPIR User Guide for Eligible Hospitals Introduction The American Recovery and Re-investment Act of 2009 was enacted on February 17, 2009. This act provides for incentive payments to Eligible Professionals (EP), Eligible Hospitals (EH), and Critical Access Hospitals to promote the adoption and meaningful use of interoperable health information technology and qualified electronic health records (EHR). The Medical Assistance Provider Incentive Repository (MAPIR) is a Web-based program administered by state Medicaid programs that allows Eligible Professionals and Eligible Hospitals to apply for incentive payments to help defray the costs of a certified EHR system. Per the final federal rule, Eligible Hospitals under the Medicaid EHR Incentive Program include: Acute Care Hospital are those hospitals with an average patient length of stay of 25 days or fewer, and with a Centers for Medicare and Medicaid Programs (CMS) Certification Number (CCN) that falls in the range 0001-0879 or 1300-1399 Separately certified children s hospitals with CCNs in the 3300 3399 range To qualify for an incentive payment under the Medicaid EHR Incentive Program, an Eligible Hospital must have a minimum 10% Medicaid patient volume requirement. Children s hospitals do not have patient volume requirements. Note: Children s Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria. To apply for the Medicaid EHR Incentive Payment Program, Eligible Hospitals must first register at the CMS Medicare and Medicaid EHR Incentive Program Registration and Attestation System (R&A). Once registered they can submit an application and attest online using MAPIR. This manual provides step-by-step directions for using MAPIR and submitting your application to the Medicaid EHR Incentive Payment Program [STATE MAY WANT TO BE MORE SPECIFIC]. Note: The Meaningful Use Stage 2 Final Rule introduced specific changes for Stage 1 functionality that take effect in Program Year 2013. MAPIR Version 5.0 was enhanced to comply with the Stage 2 Final Rule. Any Program Year 2013 applications that are started prior to the implementation of MAPIR Version 5.0 will follow the processing logic that was in effect for the version of MAPIR that [STATE] was using prior to implementing MAPIR Version 5.0. [STATE MAY WANT PROVIDE ADDITIONAL INSTRUCTIONS]. February 25, 2013 1

MAPIR User Guide for Eligible Hospitals Before You Begin Before You Begin There are several pre-requisites to applying for state Medicaid EHR Incentive payments using MAPIR. 1. Complete your CMS Medicare & Medicaid EHR Incentive Program Registration and Attestation System (R&A) registration. 2. Identify one individual from your organization who will be responsible for completing the MAPIR application and attestation information. This person can also serve as a contact point for state Medicaid communications. 3. Gather the necessary information to facilitate the completion of the application and attestation process. Complete your R&A registration. You must register at the R&A before accessing MAPIR. If you access MAPIR and have not completed this registration, you will receive the following screen: Please access the federal Web site below for instructions on how to do this or to register. For general information regarding the Incentive Payment Program: http://www.cms.gov/ehrincentiveprograms To register: https://ehrincentives.cms.gov/hitech/login.action You will not be able to start your MAPIR application process unless you have successfully completed this federal registration process. Once MAPIR has received and matched your provider information, you will receive an email to begin the MAPIR application process. Please allow at least two days from the time you complete your federal registration before accessing MAPIR due to the necessary exchange of data between these two systems. 2 February 25, 2013

Before You Begin MAPIR User Guide for Eligible Hospitals Changes to your R&A Registration Please be aware that when accessing your R&A registration information, should any changes be initiated but not completed, the R&A may report your registration as In Progress. This will result in your application being placed in a hold state within MAPIR until the R&A indicates that any pending changes have been finalized. You must complete your registration changes at the R&A prior to accessing MAPIR or certain capabilities will be unavailable. For example, it will not be possible to submit your application, create a new application, or abort an incomplete application. If you access MAPIR to perform the above activities and have not completed your registration changes, you will receive the following screen. Medicaid Hospital 1234567890 Our records indicate that your registration is in progress at the CMS Medicare and Medicaid EHR Incentive Payment Program Registration and Attestation System (R&A) and you must complete that registration process before you can access your application here. The R&A website https://www.cms.gov/ehrincentiveprograms/20_registrationandattestation.asp will have instructions on how to save your registration after a modification. You must choose Submit Registration at the R&A after you have reviewed and confirmed the information is correct. Please allow 24 to 48 hours after saving your registration at the R&A before accessing your EHR Medicaid Incentive application. If you have successfully completed the CMS R&A registration, please contact <state defined ID> for assistance. Should the R&A report your registration as In Progress and an application be incomplete or under review (following the application submission), MAPIR will send an email message reporting that such notification has been received if a valid email address was provided by either the R&A, or by the provider on the incentive application in MAPIR. Please allow at least two days from the time you complete your federal registration changes before accessing MAPIR due to the necessary exchange of data between these two systems. Identify one individual to complete the MAPIR application. MAPIR is accessed through the secure provider portal [STATE SHOULD UPDATE WITH NAME OF THEIR STATE-SPECIFIC PORTAL]. Once an individual has started the MAPIR application process with their Internet/portal account, they cannot switch to another account during that program year. MAPIR will allow the user to save the information entered and return later to complete an application; however, only the same individual s Internet/portal account will be permitted access to the application after it has been started. February 25, 2013 3

MAPIR User Guide for Eligible Hospitals Using MAPIR Gather the necessary information to facilitate the completion of the required data. MAPIR will request specific information when you begin the application process. To facilitate the completion of the application, it is recommended that you review [STATE- SPECIFIC DIRECTION MAY BE ADDED HERE OR DIRECTION TO A WEBSITE OR INFORMATION THEY SHOULD REFERENCE] to understand what information will be required. At a minimum, you should have the following information available: Information submitted to the R&A Medicaid Patient Volume and associated timeframes The CMS EHR Certification ID that you obtained from the ONC Certified Health IT Product List (CHPL) Web site (http://onc-chpl.force.com/ehrcert). Using MAPIR MAPIR uses a tab arrangement to guide you through the application. You must complete the tabs in the order presented. You can return to previous tabs to review the information or make modifications until you submit the application. You cannot proceed without completing the next tab in the application progression, with the exception of the Get Started and Review tabs which you can access anytime. Once you submit your application, you can no longer modify the data. It will only be viewable through the Review tab. Also, the tab arrangement will change after submission to allow you to view status information. As you proceed through the application process, you will see your identifying information such as Name, National Provider Identifier (NPI), CMS Certification Number, Tax Identification Number (TIN), Payment Year, and Program Year at the top of most screens. This is information provided by the R&A. A Print link is displayed in the upper right-hand corner of most screens to allow you to print information entered. You can also use your Internet browser print function to print screen shots at any time within the application. There is a Contact Us link with contact instructions should you have questions regarding MAPIR or the Medicaid Incentive Payment Program. Most MAPIR screens display an Exit link that closes the MAPIR application window. If you modify any data in MAPIR without saving, you will be asked to confirm if the application should be closed (as shown to the right). You should use the Save & Continue button on the screen before exiting or data entered on that screen will be lost. The Previous button always displays the previous MAPIR application window without saving any changes to the application. The Reset button will restore all unsaved data entry fields to their original values. The Clear All button will remove standard activity selections for the screen in which you are working. A red asterisk (*) indicates a required field. Help icons located next to certain fields display help content specific to the associated field when you hover the mouse over the icon. Note: Use the MAPIR Navigation buttons in MAPIR to move to the next and previous screens. Do not use the browser buttons as this could result in unexpected results. 4 February 25, 2013

Using MAPIR MAPIR User Guide for Eligible Hospitals As you complete your incentive application you may receive validation messages requiring you to correct the data you entered. These messages will appear above the navigation button. See the Additional User Information section for more information. Many MAPIR screens contain help icons to give the provider additional details about the information being requested. Moving your cursor over the will reveal additional text providing more details. February 25, 2013 5

MAPIR User Guide for Eligible Hospitals Step 1 Getting Started Step 1 Getting Started Log in to the state Medicaid portal and locate the MAPIR link. Click the link to access the MAPIR screen. The screen below, the Medicaid EHR Incentive Program Participation Dashboard, is the first screen you will see when you begin the MAPIR application process. This screen displays your incentive applications. Only the incentive applications that you are eligible to apply for are enabled. The Status will vary, depending on your progress with the incentive application. The first time you access the system the status should be Not Started. From this screen you can choose to edit and view incentive applications in an Incomplete or Not Started status. You can only view incentive applications that are in a Completed, Denied, or Expired status. Also from this screen, you can choose to abort an incentive application that is in an Incomplete status. When you click Abort on an incentive application, all progress will be eliminated for the incentive application. When an incentive application has completed the payment process, the status will change to Completed. Select an application and click Continue. Note: A state may allow a grace period which extends the specific Payment Year for a configured length of time. If two applications are showing for the same Payment Year, but different Program Years, one of your incentive applications is in the grace period. In this situation, the following message will display at the bottom of the screen. 6 February 25, 2013

Step 1 Getting Started MAPIR User Guide for Eligible Hospitals You are in the grace period for program year <Year> which began on <Date> and ends on <Date>. The grace period extends the amount of time to submit an application for the previous program year. You have the option to choose the previous program year or the current program year. You may only submit an application for one Program Year so once you select the application, the row for the application for the other Program Year will no longer display. If the incentive application is not completed by the end of the grace period, the status of the application will change to Expired and you will no longer have the option to submit the incentive application for that Program Year. The following screen will display with the information for the incentive application you selected. A status of Not Registered at R&A indicates that you have not registered at the R&A, or the information provided during the R&A registration process does not match that on file with the state Medicaid Program. A Status of Registration In Progress indicates that you have initiated but not completed R&A registration changes. If you feel this status is not correct you can click the Contact Us link in the upper right for information on contacting the state Medicaid program office. A status of Not Started indicates that the R&A and state MMIS information have been matched and you can begin the application process. The Status will vary, depending on your progress with the application. The first time you access the system the status should be Not Started. For more information on statuses, refer to the Additional User Information section later in this guide. Click Get Started to access the Get Started screen or Exit to close the program. If you selected an incentive application that you are not associated with, you will receive a message indicating that a different Internet/Portal account has already started the Medicaid EHR Incentive Payment Program application process and that the same Internet/Portal account must be used to access the February 25, 2013 7

MAPIR User Guide for Eligible Hospitals Step 1 Getting Started application for this Provider ID. If you are the new user for the provider and want to access the previous applications, you will need to contact your <Single State Defined ID> for assistance. Click Confirm to associate the current Internet/portal account with this incentive application. The Get Started screen contains information that includes your facility Name and Applicant NPI. Also included is the current status of your application. Click Begin to proceed to the R&A/Contact Info section. 8 February 25, 2013

Step 2 Confirm R&A and Contact Info MAPIR User Guide for Eligible Hospitals Step 2 Confirm R&A and Contact Info When you completed the R&A registration, your registration information was sent to the state Medicaid program. This section will ask you to confirm the information sent by the R&A and matched with the state Medicaid program information. It is important to review this information carefully. The R&A information can only be changed at the R&A but Contact Information can be changed at any time prior to application submission. The initial R&A/Contact Info screen contains information about this section. Click Begin to access the R&A/Contact Info screen to confirm information and to enter your contact information. See the Using MAPIR section of this guide for information on using the Print, Contact Us, and Exit links. Check your information carefully to ensure all of it is accurate. Compare the R&A Registration ID you received when you registered with the R&A with the R&A Registration ID that is displayed. After reviewing the information click Yes or No. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel back to the starting point. The Reset button will not reset R&A information. If the R&A information is not correct you will need to return to the R&A to correct it. February 25, 2013 9

MAPIR User Guide for Eligible Hospitals Step 2 Confirm R&A and Contact Info 10 February 25, 2013

Step 2 Confirm R&A and Contact Info MAPIR User Guide for Eligible Hospitals Enter a Contact Name and Contact Phone. Enter a Contact Email Address twice for verification. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel back to the starting point. February 25, 2013 11

MAPIR User Guide for Eligible Hospitals Step 2 Confirm R&A and Contact Info This screen confirms you successfully completed the R&A/Contact Info section. Note the check box located in the R&A/Contact Info tab. You can return to this section to update the Contact Information at any time prior to submitting your application. Click Continue to proceed to the Eligibility section. 12 February 25, 2013

Step 3 Eligibility MAPIR User Guide for Eligible Hospitals Step 3 Eligibility The Eligibility section will ask questions to allow the state Medicaid program to make a determination regarding your eligibility for the Medicaid EHR Incentive Payment Program. You will also enter your required CMS EHR Certification ID. The initial Eligibility screen contains information about this section. Click Begin to proceed to the Eligibility Questions (Part 1 of 2). February 25, 2013 13

MAPIR User Guide for Eligible Hospitals Step 3 Eligibility Select Yes or No to the eligibility questions. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. 14 February 25, 2013

Step 3 Eligibility MAPIR User Guide for Eligible Hospitals The Eligibility Questions (Part 2 of 2) screen asks for information about your CMS EHR Certification ID. Enter the 15-character CMS EHR Certification ID. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel back to the starting point. The system will perform an online validation of the CMS EHR Certification ID you entered. A CMS EHR Certification ID can be obtained from the Office of the National Coordinator (ONC) Certified Health IT Product List (CHPL) website (http://onc-chpl.force.com/ehrcert) February 25, 2013 15

MAPIR User Guide for Eligible Hospitals Step 3 Eligibility This screen confirms you successfully entered your CMS EHR Certification ID. Click Save & Continue to continue, or click Previous to go back. 16 February 25, 2013

Step 3 Eligibility MAPIR User Guide for Eligible Hospitals This screen confirms you successfully completed the Eligibility section. Note the check box in the Eligibility tab. Click Continue to proceed to the Patient Volumes section. February 25, 2013 17

MAPIR User Guide for Eligible Hospitals Step 4 - Patient Volumes Step 4 - Patient Volumes The Patient Volumes section gathers information about your facility locations, the 90-day period you intend to use for reporting the Medicaid patient volume requirement, and the actual patient volumes. Additionally, you will be asked about how you utilize your certified EHR technology. There are three parts to the Patient Volumes section: Part 1 of 3 establishes the 90-day period for reporting patient volumes. Part 2 of 3 contains screens to enter locations for reporting Medicaid Patient Volumes and at least one location for Utilizing Certified EHR Technology, adding locations, and entering patient volumes for the chosen reporting period. Part 3 of 3 contains screens to enter your hospital Patient Volume Cost Data information. This information will be used to calculate your hospital incentive payment amount. Children s hospitals (separately certified children s hospitals with CCNs in the 3300 3399 range) are not required to meet the 10% Medicaid patient volume requirement. Based on a hospital s CCN, MAPIR will bypass these patient volume screens. The initial Patient Volumes screen contains information about this section. If you represent a Children s hospital, click Begin to go to the Patient Volume Cost Data (Part 3 of 3), page 27 in this guide, to bypass entering patient volumes and adding locations. If you represent an Acute Care or Critical Access Hospital, click Begin to proceed to the Patient Volume 90 Day Period (Part 1 of 3) screen. 18 February 25, 2013

Patient Volume (Part 1 of 3) 90 Day Reporting Period MAPIR User Guide for Eligible Hospitals Patient Volume (Part 1 of 3) 90 Day Reporting Period The Patient Volume (Part 1 of 3) - 90 Day Reporting Period section collects information about the Medicaid Patient Volume reporting period. Enter the start date for the 90 day reporting period in which you will demonstrate the required Medicaid patient volume participation level. Select if you would like your 90 day reporting period to be from either the Last Completed Fiscal Year Preceding the Payment Year or the 12 Months Preceding Attestation Date. Enter a Start Date or select one from the calendar icon located to the right of the Start Date field. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel back to the starting point or last saved values. February 25, 2013 19

MAPIR User Guide for Eligible Hospitals Patient Volume (Part 1 of 3) 90 Day Reporting Period Review the Start Date and End Date information. The 90 Day End Date has been calculated for you. Click Save & Continue to review your selection, or click Previous to go back. 20 February 25, 2013

Patient Volume (Part 2 of 3) - Location MAPIR User Guide for Eligible Hospitals Patient Volume (Part 2 of 3) - Location In order to meet the requirements of the Medicaid EHR Incentive Program, you must provide information about your facility. The information will be used to determine your eligibility for the incentive program. Facility locations MAPIR will present a list of locations that the state Medicaid program office has on record. If you have additional locations you will be given the opportunity to add them. Once all locations are added, you will enter the required Patient Volume information. Review the listed locations. Add new locations by clicking Add Location. February 25, 2013 21

MAPIR User Guide for Eligible Hospitals Patient Volume (Part 2 of 3) - Location If you clicked Add Location on the previous screen, you will see the following screen. Enter the requested information for your new location. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. 22 February 25, 2013

Patient Volume (Part 2 of 3) - Location MAPIR User Guide for Eligible Hospitals This screen shows one location on file and one added location. Click Edit to make changes to the added location or Delete to remove it from the list. Note: The Edit and Delete options are not available for locations already on file. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. February 25, 2013 23

MAPIR User Guide for Eligible Hospitals Patient Volume (Part 2 of 3) - Location Click Begin to proceed to the screens where you will enter patient volumes. Enter Patient Volumes for each of the locations listed on the screen. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. 24 February 25, 2013

Patient Volume (Part 2 of 3) - Location MAPIR User Guide for Eligible Hospitals This screen displays the patient volumes you entered, all values summarized, and the Medicaid Patient Volume Percentage. The Medicaid Patient Volume Percentage Formula is: (Medicaid Discharges + Other Medicaid Discharges) Divided by Total Discharges All Lines of Business Note the Total % patient volume field. This percentage must be greater than or equal to 10% to meet the Medicaid patient volume requirement. Click Save & Continue to continue, or Previous to go back. February 25, 2013 25

MAPIR User Guide for Eligible Hospitals Patient Volume (Part 2 of 3) - Location 26 February 25, 2013

Hospital Cost Report Data Fiscal Year (Part 3 of 3) MAPIR User Guide for Eligible Hospitals Hospital Cost Report Data Fiscal Year (Part 3 of 3) The following screens will request hospital cost data. This information will be used to calculate your hospital incentive payment amount. The total hospital incentive payment is calculated in your first payment year and distributed over the number of years defined by the state Medicaid program. To receive subsequent year payments you must attest to the eligibility requirements, patient volume requirements (except Children s hospitals), and meaningful use each year. Enter the Start Date of the hospital fiscal year that ends during the Federal fiscal year prior to the fiscal year that serves as the first payment year, or select one from the calendar icon located to the right of the Start Date field. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. February 25, 2013 27

MAPIR User Guide for Eligible Hospitals Hospital Cost Report Data Fiscal Year (Part 3 of 3) This screen displays your Fiscal Year Start Date and the Fiscal Year End Date. If the Fiscal Year Start and End Dates are correct, click Save & Continue to review your selection, or click Previous to go back. 28 February 25, 2013

Hospital Cost Report Data (Part 3 of 3) MAPIR User Guide for Eligible Hospitals Hospital Cost Report Data (Part 3 of 3) On this screen you will enter the hospital cost report data required to calculate your incentive payment. In the first column enter Total Discharges for the Fiscal Years displayed to the left. Enter the Total Inpatient Medicaid Bed Days, Total Inpatient Bed Days, Total Charges All Discharges, and Total Charges Charity Care. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. If you are in Payment Year 2 or subsequent payment years, this screen will display the hospital cost report data from the previous paid application. If you would like to change the hospital cost report data, refer to the Change Hospital Cost Report Data section of this manual. If you would like to proceed using the existing hospital cost report data from the previous paid application, click Save & Continue. If you are accessing MAPIR for the first time and received one or more incentive payments from another state, the Hospital Cost Report Data (Part 3 of 3) screen will display zeroes. You will not be able to enter data. After submitting your application, contact the <State Contact Information>. February 25, 2013 29

MAPIR User Guide for Eligible Hospitals Hospital Cost Report Data (Part 3 of 3) Review the numbers you entered. Click Save & Continue to continue, or click Previous to go back. 30 February 25, 2013

Hospital Cost Report Data (Part 3 of 3) MAPIR User Guide for Eligible Hospitals This screen confirms you successfully completed the Patient Volumes section. Note the check box in the Patient Volumes tab. Click Continue to proceed to the Attestation section. February 25, 2013 31

MAPIR User Guide for Eligible Hospitals Change Hospital Cost Report Data Change Hospital Cost Report Data When you have applied since the start of the program in the same state and your payment year is 2 or higher, MAPIR allows you to revise previously entered hospital cost report data. The Hospital Cost Report Data screen will display the data from the previously paid application. The revised hospital cost report data that you enter will be referenced when MAPIR calculates your total EHR incentive amount, overriding any amount for previous years. When viewing any previous applications, MAPIR will continue to display the cost report data that was entered originally for reference purposes only. The fiscal years entered on the payment year 1 application cannot be changed. From the Hospital Cost Report Data screen, click Change Data. 32 February 25, 2013

Change Hospital Cost Report Data MAPIR User Guide for Eligible Hospitals Confirm if you want to proceed to change the hospital cost report data. Be advised that if you elect to proceed the data that was previously entered for hospital cost report data will be erased. Click Confirm to proceed. Click Cancel to return to the previous screen. February 25, 2013 33

MAPIR User Guide for Eligible Hospitals Change Hospital Cost Report Data On this screen you will re-enter the hospital cost report data required to calculate your incentive payment. In the first column enter Total Discharges for the Fiscal Years displayed to the left. Enter the Total Inpatient Medicaid Bed Days, Total Inpatient Bed Days, Total Charges All Discharges, and Total Charges Charity Care. Click Save & Continue to review your selection, or click Previous to go back to the existing hospital cost report data. Click Reset to restore this panel to the starting point. If you re-enter the hospital cost report data and the values match the existing hospital cost report data on file, you will receive an error message. The re-entered data cannot match the existing data on file. 34 February 25, 2013

Change Hospital Cost Report Data MAPIR User Guide for Eligible Hospitals Review your revised hospital cost report data. Once you save the revised hospital cost report data you cannot revert to the hospital cost report data on file. At this point, if you decide you do not want to revise the existing hospital cost data on file, abort the current application and start over again. Click Save & Continue to continue with new amounts, click Previous to go back to the first Hospital Cost Report Data screen, or click Change Data to change the data again. Once you have submitted the application, MAPIR recalculates the incentive payment for that year based on the revised hospital cost data as well as the remaining payments. If the new calculation results in a revised payment for the current year, you will receive a payment for the revised amount. February 25, 2013 35

MAPIR User Guide for Eligible Hospitals Change Hospital Cost Report Data This screen confirms you successfully completed the Patient Volumes section. Note the check box in the Patient Volumes tab. Click Continue to proceed to the Attestation section. 36 February 25, 2013

Change Hospital Cost Report Data MAPIR User Guide for Eligible Hospitals Step 5 Attestation This section will ask you to provide information about your EHR System Adoption Phase. Adoption phases include Adoption, Implementation, Upgrade, and Meaningful Use. Based on the adoption phase you select, you may be asked to complete additional information about activities related to that phase. For the first year of participation in the Medicaid EHR Incentive program, Eligible Hospitals will have the option to attest to Adoption, Implementation, Upgrade, or Meaningful Use. After the first year of participation, the Eligible Hospitals are required to attest to Meaningful Use. This initial Attestation screen provides information about this section. Click Begin to continue to the Attestation section. If you are a Dually Eligible Hospital, but have not been approved for Meaningful Use Attestation during the current Program Year at the CMS Medicare & Medicaid EHR Incentive Program Registration and Attestation System (R&A), you will not be permitted to proceed with the MAPIR application process until you have completed this process at the R&A. Click Exit to exit the MAPIR application or select any of the previously completed tabs. February 25, 2013 37

MAPIR User Guide for Eligible Hospitals Attestation Phase (Part 1 of 3) Attestation Phase (Part 1 of 3) The Attestation Phase (Part 1 of 3) screen asks for the EHR System Adoption Phase. The screen shown below is the Attestation Phase (Part 1 of 3) screen you will see if it is your first year participating (Payment Year 1). If it is not your first year participating (Payment Year 2 or beyond), turn to page 49 of this guide. If you have registered at the R&A as a Dually Eligible hospital and are Deemed Eligible, you will bypass the Attestation Phase (Part 1 of 3). Proceed to page 143 of this guide. After making your selection, the next screen you see will depend on the phase you selected. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. For Adoption continue to the next page of this guide. For Implementation turn to page 40 of this guide. For Upgrade turn to page 44 of this guide. For Meaningful Use turn to page 48 of this guide. 38 February 25, 2013

Adoption Phase MAPIR User Guide for Eligible Hospitals Adoption Phase For Adoption select the Adoption button. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. Proceed to page 143 of this guide. February 25, 2013 39

MAPIR User Guide for Eligible Hospitals Implementation Phase (Part 2 of 3) Implementation Phase (Part 2 of 3) For Implementation select the Implementation button. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. 40 February 25, 2013

Implementation Phase (Part 2 of 3) MAPIR User Guide for Eligible Hospitals Select your Implementation Activity by selecting the Planned or Complete button. Click Other to add any additional Implementation Activities you would like to supply. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. After saving, click Clear All to remove standard activity selections. February 25, 2013 41

MAPIR User Guide for Eligible Hospitals Implementation Phase (Part 2 of 3) This screen shows an example of entering activities other than what was in the Implementation Activity listing. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore the panel to the starting point. After saving, click Clear All to remove standard activity selections. 42 February 25, 2013

Implementation Phase (Part 2 of 3) MAPIR User Guide for Eligible Hospitals Review the Implementation Activity you selected. Click Save & Continue to continue, or click Previous to go back. Proceed to page 143 of this guide to continue. February 25, 2013 43

MAPIR User Guide for Eligible Hospitals Upgrade Phase (Part 2 of 3) Upgrade Phase (Part 2 of 3) For Upgrade select the Upgrade button. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. 44 February 25, 2013

Upgrade Phase (Part 2 of 3) MAPIR User Guide for Eligible Hospitals Select your Upgrade Activities by selecting the Planned or Complete button for each activity. Click Other to add any additional Upgrade Activities you would like to supply. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore the panel to the starting point. After saving, click Clear All to remove standard activity selections. February 25, 2013 45

MAPIR User Guide for Eligible Hospitals Upgrade Phase (Part 2 of 3) This screen shows an example of entering activities other than what was in the Upgrade Activity listing. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore the panel to the starting point. After saving, click Clear All to remove standard activity selections. 46 February 25, 2013

Upgrade Phase (Part 2 of 3) MAPIR User Guide for Eligible Hospitals Review the Upgrade Activities you selected. Click Save & Continue to proceed or Previous to return. Proceed to page 143 of this guide to continue. February 25, 2013 47

MAPIR User Guide for Eligible Hospitals Meaningful Use Phase Meaningful Use Phase For Meaningful Use select the Meaningful Use button. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. 48 February 25, 2013

Meaningful Use Phase MAPIR User Guide for Eligible Hospitals Select a 90-day period or a full year period for reporting Meaningful Use of certified EHR technology. If you selected Meaningful Use in the Attestation Phase for Payment Year 1, your only option on this screen for Payment Year 2 and beyond will be the Meaningful Use (Full Year). Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. February 25, 2013 49

MAPIR User Guide for Eligible Hospitals Meaningful Use Phase Depending on the selection made on the previous screen, the Attestation EHR Reporting Period (Part 1 of 3) screen will display with the 90-day period or the full year period. The example below displays the 90- day period. Enter a Start Date or use the calendar located to the right of the Start Date field. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. 50 February 25, 2013

Meaningful Use Phase MAPIR User Guide for Eligible Hospitals This screen shows an example of a Start Date of May 1, 2011 and a system-calculated End Date of July 29, 2011. Click Save & Continue to review your selection, or click Previous to go back. February 25, 2013 51

MAPIR User Guide for Eligible Hospitals Attestation Meaningful Use Measures Attestation Meaningful Use Measures This screen starts a series of screens related to the Meaningful Use Measure. Click Yes or No to the first question. Click Save & Continue to proceed to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. 52 February 25, 2013

Attestation Meaningful Use Measures MAPIR User Guide for Eligible Hospitals The screen below displays the Measures Topic List. The Attestation Meaningful Use Measures are divided into three distinct topics: Core Measures, Menu Set Measures, and Clinical Quality Measures. You may select any of the three topics and complete them in any order. All three topics must be completed. Click Begin to start a topic. February 25, 2013 53

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures Meaningful Use Core Measures While it is not required that you begin each topic in the order shown on the screen, this user guide will follow the order in which the topics are listed. This screen provides information about the Meaningful Use Core Measures. Please note that per the Stage 2 Final Rule, Meaningful Use Core Measures 9 and 13 are no longer available for attestation. Click Begin to continue to the Meaningful Use Core Measure List Table. 54 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals The screen on the following page displays the Meaningful Use Core Measure List Table. The first time a topic is accessed you will see an Edit option for each measure. Once information is successfully entered and saved for a measure it will be displayed in the Entered column on this screen. Click Edit to enter or edit information for a measure or click Return to return to the Measures Topic List. February 25, 2013 55

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures 56 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals Measure Selection for Core Measure 1 (Measure Code EHCMU01) Choose if you would like to attest to the Original Core Measure 1 or the Optional Core Measure 1. If you return at a later time and change your selection, any information entered for the measure prior to that point will be removed. Click Save & Continue to proceed to the appropriate core measure screen for the option you selected or click Previous to go back. If you selected the Original Core Measure 1, continue to the next page. If you selected the Optional Core Measure 1, continue to page 59. February 25, 2013 57

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures Original Core Measure 1 (Measure Code EHCMU01) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator entered. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 58 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals Optional Core Measure 1 (Measure Code EHCMU01) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator entered. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 59

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures After you enter information for a measure click the Save & Continue, you will be returned to the Meaningful Use Core Measure List Table. The information you entered for that measure will be displayed in the Entered column of the table as shown in the example below (please note that the entire screen is not displayed in this example). You can continue to edit the measures at any point prior to submitting the application. Click Edit for the next measure. 60 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals Core Measure 2 (Measure Code EHCMU02) Enter information in all required fields. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 61

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures Core Measure 3 (Measure Code EHCMU03) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 62 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals Core Measure 4 (Measure Code EHCMU04) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 63

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures Core Measure 5 (Measure Code EHCMU05) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 64 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals Core Measure 6 (Measure Code EHCMU06) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 65

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures Measure Selection for Core Measure 7 (Measure Code EHCMU07) Choose if you would like to attest to the Original Core Measure 7 or the Optional Core Measure 7. If you return at a later time and change your selection, any information entered for the measure prior to that point will be removed. Click Save & Continue to proceed to the appropriate core measure screen for option you selected or click Previous to go back. If you selected the Original Core Measure 7, continue to the next page. If you selected the Optional Core Measure 7, continue to page 68. 66 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals Original Core Measure 7 (Measure Code EHCMU07) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 67

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures Optional Core Measure 7 (Measure Code EHCMU07) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 68 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals Core Measure 8 (Measure Code EHCMU08) Enter information in all required fields. If the exclusion applies to you, refer to the screen on the next page. If the exclusion does not apply to you, select No to the exclusion and enter a numerator and denominator. The denominator entered must be greater than or equal to the numerator. In the example below, the exclusion does not apply. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 69

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures If the exclusion applies to you, select Yes to the exclusion and do not enter a numerator and denominator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 70 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 71

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures Core Measure 10 (Measure Code EHCMU10) Enter information in all required fields. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 72 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals Core Measure 11 (Measure Code EHCMU11) Enter information in all required fields. If the exclusion applies to you, refer to the screen on the following page. If the exclusion does not apply to you, answer the Patient Records question, select No to the exclusion, and enter a numerator and denominator. The denominator entered must be greater than or equal to the numerator. In the example below, the exclusion does not apply. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 73

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures 74 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals If the exclusion applies to you, answer the Patient Records question, select Yes to the exclusion, and do not enter a numerator and denominator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 75

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures Core Measure 12 (Measure Code EHCMU12) Enter information in all required fields. If the exclusion applies to you, refer to the screen on the following page. If the exclusion does not apply to you, answer the Patient Records question, select No to the exclusion and enter a numerator and denominator. The denominator entered must be greater than or equal to the numerator. In the example below, the exclusion does not apply. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 76 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 77

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures If the exclusion applies to you, answer the Patient Records question, select Yes to the exclusion, and do not enter a numerator and denominator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 78 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals Core Measure 14 (Measure Code EHCMU14) Enter information in all required fields. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 79

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures Once you attested to all the measures for this topic, click Return to return to the Measures Topic List. 80 February 25, 2013

Meaningful Use Core Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 81

MAPIR User Guide for Eligible Hospitals Meaningful Use Core Measures If all measures were entered and saved, a check mark will display under the Completed column for the topic as displayed in the example below. You can continue to edit the topic measure after it has been marked complete. Click the Edit button to further edit the topic, click Clear All to clear all topic information you entered, or click Begin to start the next topic. 82 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures This initial screen provides information about the Menu Set Measures. Click Begin to continue to the Menu Set Measures section. February 25, 2013 83

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures From the screen on the following page, choose five Meaningful Use Menu Measures to attest to. One measure must be from the public health list (first three measures listed on the top half of the screen). The remainder of the measures can be any combination from the remaining public health list measures or from the additional Meaningful Use Menu Measures listed. In the example shown on the following page, one public health measure and four measures from the additional Meaningful Use Measures listed are selected. If a measure is selected and information is entered for that measure, unselecting the measure will clear all information previously entered. Click Save & Continue to proceed, or click Return to go back. Click Reset to restore this panel to the starting point. 84 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 85

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures The five measures you selected to attest to will display on the Meaningful Use Menu Measure Worksheet. The example below displays the five measures selected on the previous screen example. You must complete all measures. Once information is successfully entered and saved for a measure it will be displayed in the Entered column on this screen. Click Edit to enter or edit information for a measure or click Previous to return to the Measures Topic List. The 10 available Meaningful Use Menu Measures are described in this user guide. Only those that you selected will apply to you. 86 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals Menu Measure 1 (Measure Code EHMMU01) Enter information in all required fields. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 87

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures After you enter information for a measure and click the Save & Continue, you will return to the Meaningful Use Core Menu Measure Worksheet. The information you entered for that measure will be displayed in the Entered column of the table as shown in the example below (please note that the entire screen is not displayed in this example). You can continue to edit the measures at any point prior to submitting the application. Click on the Edit button for the next measure. 88 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals Menu Measure 2 (Measure Code EHMMU02) Enter information in all required fields. If the exclusion applies to you, see the screen on the following page. If the exclusion does not apply to you, answer the Patient Records question, select No to the exclusion and enter a numerator and denominator. The denominator entered must be greater than or equal to the numerator. In the example below, the exclusion does not apply. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 89

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures If the exclusion applies to you, answer the Patient Records question, select Yes to the exclusion and do not enter a numerator and denominator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 90 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 91

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures Menu Measure 3 (Measure Code EHMMU03) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 92 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 93

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures Menu Measure 4 (Measure Code EHMMU04) Enter information in all required fields. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 94 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals Menu Measure 5 (Measure Code EHMMU05) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 95

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures Menu Measure 6 (Measure Code EHMMU06) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 96 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals Menu Measure 7 (Measure Code EHMMU07) Enter information in all required fields. The denominator entered must be greater than or equal to the numerator. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 97

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures Menu Measure 8 (Measure Code EHMMU08) Enter information in all required fields. If Exclusion 1 and/or Exclusion 2 apply to you, refer to the screen on the following page. If Exclusion 1 and 2 do not apply to you, select No to the exclusions and do not answer the reason for exclusion question. In the example below, the exclusion does not apply. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 98 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 99

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures If Exclusion 1 and/or Exclusion 2 apply to you select Yes. If you selected yes to Exclusion 1, select one of the statements listed that best describes the reason for the exclusion. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 100 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 101

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures Menu Measure 9 (Measure Code EHMMU09) Enter information in all required fields. If the exclusion applies to you, refer to the screen on the following page. In the example below, the exclusion does not apply. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. 102 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals If the exclusion applies to you, select Yes to the exclusion. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 103

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures 104 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals Menu Measure 10 (Measure Code EHMMU10) Enter information in all required fields. If the exclusion applies to you, refer to the screen on the following page. If the exclusion does not apply to you, select No to the exclusion and do not answer the exclusion question. In the example below, the exclusion does not apply. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 105

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures 106 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals If the exclusion applies to you, select Yes to the exclusion and answer the exclusion question. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore this panel to the starting point. February 25, 2013 107

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures 108 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals Once you attested to all the measures for this topic, click Previous to return to the Attestation Meaningful Use Measures screen. February 25, 2013 109

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures Click Return to return to the Measure Topic List. 110 February 25, 2013

Meaningful Use Menu Set Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 111

MAPIR User Guide for Eligible Hospitals Meaningful Use Menu Set Measures If all measures were entered and saved, a check mark will display under the Completed column for the topic. You can continue to edit the topic measure after it has been marked complete. Click the Edit button to further edit the topic, click Clear All to clear all topic information you entered, or click Begin to start the next topic. 112 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures This initial screen provides information about the Clinical Quality Measures. Click Begin to continue to the Meaningful Use Clinical Quality Measure Worklist Table. February 25, 2013 113

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures The screen on the following page displays the Meaningful Use Clinical Quality Measure Worklist Table. You must complete all measures. Once information is successfully entered and saved for a measure it will be displayed in the Entered column on this screen. Click Edit to enter or edit information for the measure or click Return to return to the Measures Topic List. 114 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 115

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures 116 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Clinical Quality Measure 1 (Measure Code NQF 0495) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. February 25, 2013 117

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures After you enter information for a measure and click Save & Continue, you will be returned to the Clinical Quality Measure List Table. The information you entered for that measure will be displayed in the Entered column of the table as shown in the example below (please note that the entire screen is not displayed in this example). You can continue to edit the measures at any point prior to submitting the application. Click the Edit button for the next measure. 118 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Clinical Quality Measure 2 (Measure Code NQF 0497) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. February 25, 2013 119

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures 120 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Clinical Quality Measure 3 (Measure Code NQF 0435) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. February 25, 2013 121

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures Clinical Quality Measure 4 (Measure Code NQF 0436) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. 122 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Clinical Quality Measure 5 (Measure Code NQF 0437) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. February 25, 2013 123

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures Clinical Quality Measure 6 (Measure Code NQF 0438) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. 124 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Clinical Quality Measure 7 (Measure Code NQF 0439) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. February 25, 2013 125

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures Clinical Quality Measure 8 (Measure Code NQF 0440) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. 126 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Clinical Quality Measure 9 (Measure Code NQF 0441) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. February 25, 2013 127

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures Clinical Quality Measure 10 (Measure Code NQF 0371) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. 128 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Clinical Quality Measure 11 (Measure Code NQF 0372) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. February 25, 2013 129

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures Clinical Quality Measure 12 (Measure Code NQF 0373) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. 130 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Clinical Quality Measure 13 (Measure Code NQF 0374) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. February 25, 2013 131

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures Clinical Quality Measure 14 (Measure Code NQF 0375) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. 132 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals Clinical Quality Measure 15 (Measure Code NQF 0376) Enter information in all required fields. The denominator, numerator, and exclusion entries must be positive whole numbers. Click Save & Continue to review your selection, click Previous to go back, or click Reset to restore the panel to the starting point. February 25, 2013 133

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures The screen on the following page displays Meaningful Use Quality Measures Worklist Table with data entered for every measure. Click Return to return to the Measures Topic List. 134 February 25, 2013

Meaningful Use Clinical Quality Measures MAPIR User Guide for Eligible Hospitals February 25, 2013 135

MAPIR User Guide for Eligible Hospitals Meaningful Use Clinical Quality Measures This screen displays the Measures Topic List with all three meaningful use measure topics marked complete. Click Save & Continue to view a summary of the Meaningful Use Measures you attested to. 136 February 25, 2013

Meaningful Use Measures Summary MAPIR User Guide for Eligible Hospitals Meaningful Use Measures Summary This screen displays a summary of all entered meaningful use attestation information. Review the information for each measure. If further edits are necessary, click Previous to return to the Measures Topic List where you can choose a topic to edit. If the information on the summary is correct, click Save & Continue to proceed to Part 3 of 3 of the Attestation Phase. February 25, 2013 137

MAPIR User Guide for Eligible Hospitals Meaningful Use Measures Summary This is screen 2 of 5 of the Meaningful Use Measures Summary. 138 February 25, 2013

Meaningful Use Measures Summary MAPIR User Guide for Eligible Hospitals This is screen 3 of 5 of the Meaningful Use Measures Summary. February 25, 2013 139

MAPIR User Guide for Eligible Hospitals Meaningful Use Measures Summary 140 February 25, 2013

Meaningful Use Measures Summary MAPIR User Guide for Eligible Hospitals This is screen 4 of 5 of the Meaningful Use Measures Summary. February 25, 2013 141

MAPIR User Guide for Eligible Hospitals Meaningful Use Measures Summary This is screen 5 of 5 of the Meaningful Use Measures Summary. 142 February 25, 2013

Attestation Phase (Part 3 of 3) MAPIR User Guide for Eligible Hospitals Attestation Phase (Part 3 of 3) Part 3 of 3 of the Attestation Phase contains questions regarding the average length of stay for your facility and confirmation of the address to which the incentive payment will be sent. Click Yes to confirm you are either an Acute Care Hospital with an average length of stay of 25 days or fewer, or a Children s Hospital. Click the Payment Address from the list below to be used for your Incentive Payment. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. February 25, 2013 143

MAPIR User Guide for Eligible Hospitals Attestation Phase (Part 3 of 3) This screen confirms you successfully completed the Attestation section. Note the check box in the Attestation tab. Click Continue to proceed to the Review tab. 144 February 25, 2013

Step 6 Review Application MAPIR User Guide for Eligible Hospitals Step 6 Review Application The Review section allows you to review all information you entered into your application. If you find errors, you can click the associated tab and proceed to correct the information. When you have corrected the information you can click the Review tab to return to this section. From this screen you can print a printer-friendly copy of your application for review. Please review all information carefully before proceeding to the Submit section. Once your application is submitted you will not have the opportunity to change it. Click Print to generate a printer-friendly version of this information. When you have finished reviewing all information click the Submit tab to proceed. February 25, 2013 145

MAPIR User Guide for Eligible Hospitals Step 6 Review Application This is screen 2 of 3 of the Review tab display. 146 February 25, 2013

Step 6 Review Application MAPIR User Guide for Eligible Hospitals This is screen 3 of 3 of the Review tab display. February 25, 2013 147

MAPIR User Guide for Eligible Hospitals Step 6 Review Application 148 February 25, 2013

Step 7 Submit Your Application MAPIR User Guide for Eligible Hospitals Step 7 Submit Your Application The final submission of your application involves the following steps: Review and Check Errors MAPIR will check your application for errors. If errors are present you will have the opportunity to go back to the section where the error occurred and correct it. If you do not want to correct the errors you can still submit your application; however, the errors may affect your eligibility and payment amount. Optional Questions - You may be asked a series of optional questions that do not affect your application. The answers will provide information to your state Medicaid program about incentive program participation. File Upload You will have the opportunity to upload PDF files with documentation supporting your application. This optional information could include additional information on patient volumes, locations, or your certified EHR system. The initial Submit screen contains information about this section. Click Begin to continue to the submission process. February 25, 2013 149

MAPIR User Guide for Eligible Hospitals Step 7 Submit Your Application This screen lists the current status of your application and any error messages identified by the system. You can correct these errors or leave them as is. You can submit this application with errors; however, errors may impact your eligibility and incentive payment amount. To correct errors: Click Review to be taken to the section in error and correct the information. To return to this section at any time click the Submit tab. Click Save & Continue to continue with the application submission. 150 February 25, 2013

Step 7 Submit Your Application MAPIR User Guide for Eligible Hospitals The Application Questionnaire screen presents optional questions. Answer the optional questions by selecting Yes or No. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore this panel to the starting point. February 25, 2013 151

MAPIR User Guide for Eligible Hospitals Step 7 Submit Your Application To upload files click Browse to navigate to the file you wish to upload. Note: Only files that are in portable data format (PDF) and a maximum of 2 megabytes (MB) in size are acceptable documentation to upload. 152 February 25, 2013

Step 7 Submit Your Application MAPIR User Guide for Eligible Hospitals The Choose file dialog box will display. Navigate to the file you want to upload and select Open. February 25, 2013 153

MAPIR User Guide for Eligible Hospitals Step 7 Submit Your Application Check the file name in the file name box. Click Upload File to begin the file upload process. 154 February 25, 2013

Step 7 Submit Your Application MAPIR User Guide for Eligible Hospitals Note the File has been successfully uploaded. message. Review the uploaded file list in the Uploaded Files box. If you have more than one file to upload, repeat the steps to select and upload a file as many times a necessary. All of the files you uploaded will be listed in the Uploaded Files section of the screen. To delete an uploaded file click the Delete button in the Available Actions column. Click Save & Continue to review your selection, or click Previous to go back. Click Reset to restore the panel to the starting point. February 25, 2013 155

MAPIR User Guide for Eligible Hospitals Step 7 Submit Your Application This screen depicts the Preparer signature screen. Click the check box to indicate you have reviewed all information. Enter your Preparer Name and Preparer Relationship. Click Sign Electronically to proceed. Click Previous to go back. Click Reset to restore this panel to the starting point. 156 February 25, 2013

Step 7 Submit Your Application MAPIR User Guide for Eligible Hospitals Your actual incentive payment will be calculated and verified by the state Medicaid program office. This screen shows an Example Payment Disbursement over 4 Years. No information is required on this screen. Note: This is the final step of the Submit process. You will not be able to make any changes to your application after submission. If you do not want to submit your application at this time you can click Exit, and return at any time to complete the submission process. To submit your application, click Submit Application at the bottom of this screen. [STATE SHOULD SHOW THE APPROPRIATE CHART BASED ON THE NUMBER OF YEARS CONFIGURED FOR PAYMENTS. THIS SCREEN SHOWS A 4 YEAR PAYMENT SCHEDULE.] February 25, 2013 157

MAPIR User Guide for Eligible Hospitals Step 7 Submit Your Application The check indicates your application has been successfully submitted. Click OK. 158 February 25, 2013

Step 7 Submit Your Application MAPIR User Guide for Eligible Hospitals When your application has been successfully submitted, you will see the application status of Submitted. Click Exit to exit MAPIR. This screen shows that your MAPIR session has ended. You should now close your browser window. February 25, 2013 159

MAPIR User Guide for Eligible Hospitals Post Submission Activities Post Submission Activities This section contains information about post application submission activities. At any time you can check the status of your application by logging into the state Medicaid portal. When you have successfully completed the application submission process you will receive an email confirming your submission has been received. You may also receive email updates as your application is processed. The screen below shows an application in a status of Completed. You can click the Review Application tab to review your application; however, you will not be able to make changes. 160 February 25, 2013

Post Submission Activities MAPIR User Guide for Eligible Hospitals Once your application has been processed by the state Medicaid program office, you can click the Submission Outcome tab to view the results of submitting your application. February 25, 2013 161

MAPIR User Guide for Eligible Hospitals Post Submission Activities The following table lists some of the statuses your application may go through. Status Not Registered at R&A Incomplete Submitted Payment Approved Payment Disbursed Partial Recoupment Received Partial Remittance Received Aborted Appeal Initiated Appeal Approved Appeal Denied Denied Completed Cancelled Future Not Eligible Not Started Expired Definition MAPIR has not received a matching registration from both the R&A and the state MMIS. The application is in a working status but has not been submitted and may still be updated by the provider. The application has been submitted. The application is locked to prevent editing and no further changes can be made. A determination has been made that the application has been approved for payment. The financial payment data has been received by MAPIR and will appear on your remittance advice. An adjustment has been requested and the total amount has not been recouped. An adjustment has been processed and a partial recoupment has been made and will appear on your remittance advice. When in this status, all progress has been eliminated for the incentive application and the application can no longer be modified or submitted. An appeal has been lodged with the proper state authority by the provider. The appeal has been approved. The appeal has been denied. A determination has been made that the provider does not qualify for an incentive payment based on one or more of the eligibility rules. The application has run a full standard process and completed successfully with a payment to the provider. An application has been set to Cancelled status only when R&A communicates a registration cancellation to MAPIR. MAPIR cancels both the registration and any associated application. This is a status that will be displayed against any application to indicate the number of future applications that the provider can apply for within the EHR Incentive Program. This is a status that will be displayed against any application whenever the provider has exceeded the limits of the program timeframe. This is a status that will be displayed against any application whenever the provider has not started an application but MAPIR received an R&A registration and has been matched to an MMIS provider. An application is set to an Expired status when an application in an Incomplete status has not been submitted within the allowable grace period for a program year or when an authorized admin user changes an application to this status after the end of the grace period. Once an application is in an Expired status, the status cannot be changed and it is only viewable to the provider. 162 February 25, 2013

Additional User Information MAPIR User Guide for Eligible Hospitals Additional User Information This section contains an explanation of additional user information, system messages, and validation messages you may receive. Start Over and Delete All Progress - If you would like to start your application over from the beginning you can click the Get Started tab. Click the here link on the screen to start over from the beginning. February 25, 2013 163

MAPIR User Guide for Eligible Hospitals Additional User Information This screen asks you to confirm your selection to start the application over and delete all information saved to date. This process can only be done prior to submitting your application. Once your application is submitted, you will not be able to start over. Click Confirm to Start Over and Delete All Progress. If you clicked Confirm you will receive the following confirmation message: To continue click OK. 164 February 25, 2013

Additional User Information MAPIR User Guide for Eligible Hospitals February 25, 2013 165

MAPIR User Guide for Eligible Hospitals Additional User Information Contact Us Clicking on the Contact Us link in the upper right corner of most screens within MAPIR will display the following state Medicaid program contact information. MAPIR Error Message This screen will appear when a MAPIR error has occurred. Follow all instructions on the screen. Click Exit to exit MAPIR. 166 February 25, 2013

Additional User Information MAPIR User Guide for Eligible Hospitals Validation Messages The following is an example of the validation message You have entered an invalid CMS EHR Certification ID. Check and reenter your CMS EHR Certification ID. The Validation Messages Table lists validation messages you may receive while using MAPIR. February 25, 2013 167